"State of Alabama, _____________ County. I, the undersigned, being first duly sworn, depose and say that I am a citizen of the City of ____________, in the State and County and reside at ______________ in the City of __________, that I desire to become a candidate for the office of district councilman for the ______ district, in the city at the election for the office to be held on the ______ day of October next and that I am duly qualified to hold the office if elected thereto and I hereby request that my name be printed upon the official ballot at the election. Signed _________. Subscribed and sworn to before me by the _______ on this ______ day of _____, 2___, and filed in this office for record on that day. _________, Judge of Probate."
Ala. Code § 45-51A-33.51 (1975)